PCN (percutaneous nephrostomy)
Percutaneous nephrostomy is a method by which radiological guidance ensures percutaneous access to the kidney. The access is also maintained through the use of a catheter.
Percutaneous nephrostomy is usually used for ineffective or complicated retrograde strategies. Includes clinical conditions:
- Obstruction of the urinary tract.
- Diversion of the urine (e.g. ureteric lesion as well as leakage of urine).
- Percutaneous procedures access (e.g. stone treatment; ureteric antegrade stenting).
- Checking for diagnosis (e.g. pyelography antegrade, an examination of Whitaker).
Contrasting of the Comprehensive contraindications
- None normally
- Diathesis with incorrect bleeding (abnormal indices of coagulation)
- Patient uncooperative
- Extreme respiratory problems
- Severe hyperkalemia and/or metabolic acidosis has not been corrected
- Urgenthemodialysis may correct metabolic disorder prior to the insertionof nephrostomy.
Procedure of PCN
Assessment of pre-procedure
- To confirm the procedure indication and evaluate renal anatomy, review all the images available and identify safe access pathways to the kidney
- To determine the possibility of hemorrhage, review the overall blood count and coagulation profile
- Get informed procedural consent
- Get good access to IV peripheral
- If required, administration of IV broad-spectrum antibiotics 1-4 hours before the procedure; sometimes even, parenteral antibiotics in septic patients.
Depending on the clinical circumstances and patient comfort, the procedure is performed in a prone, inclined, or lateral position. During the procedure, it is recommended that a properly trained specialist monitor vital signs. Clean skin with antiseptic solution and drape to keep the procedure sterile.
- Guidelines for ultrasound or fluoroscopy
- 7-9 French mist dilators
- 1 or 2 percent lidocaine local anesthesia
- water-soluble contrast media
- A micropuncture set with a needle of 21 or 22 gages would serve as an option
- The stiff guidewire of 0.035 “(Micropuncture set also has a 0.018 guidewire)
- 8 French pigtail drain
- prophylactic antibiotics, chosen patients the usage of antibiotics is usually 3rd generation of cephalosporin, not normal.
- Fentany l, not used routinely but can assist with collaborations with patients selected (e.g. meperidine).
- Sedation-a short-acting benzodiazepine in selected patients may be used.
There are two common methods.
The selection of the technology depends on the operator and the patient. A two or three-part punching point needle, and a micropuncture set are used in one method.
The calyx is penetrated with an 18 inch, two-part needle under ultrasound direction by way of the aseptic procedure and subsequent penetration of local anesthesia agents. Urine drains freely from the needle in the event of a renal tract obstruction. To validate the right needle location with fluoroscopy, a limited volume of water-soluble contrast content may be inserted. The needle is replaced by a guidewire 0.035 and an 8 French pigtail drain is typically placed over the guidewire within the renal pelvic pelvis.
A catheter 6F or 12F on a case-by-case basis can be used. For microbiological studies, a urine sample can be sent to the lab. The catheter remains free to drain.
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